By William Elwood Byerly
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Extra info for An introduction to generalized coordinates in mechanics and physics
Impact of time to treatment with primary PCI on infarct size and myocardial reperfusion: Results from the EMERALD trial. AJC 2005; 96 (Suppl 7A):65H. 10. Stone GW, Dixon SR, Grines CL, et al. Predictors of infarct size after primary coronary angioplasty in acute myocardial infarction from pooled analysis from four contemporary trials. Am J Cardiol 2007; 100:1370–1375. 11. Tarantini G, Cacciavillani L, Corbetti F, et al. Duration of ischemia is a major determinant of transmurality and severe microvascular obstruction after primary angioplasty: A study performed with contrast-enhanced magnetic resonance.
Relationship of symptom-onset-toballoon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000; 283(22):2941–2947. 20. Stenestrand U, Lindback J, Wallentin L. Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 2006; 296(14):1749–1756. 21. Randomised trial of late thrombolysis in patients with suspected acute myocardial infarction.
3% vs. 14) [Fig. 2(E)]. Thus, despite the negative results of the FINESSE trial (19), there is evidence of beneficial effects of early GP IIb/IIIa inhibitors administration that should still be considered a reasonable strategy, especially in high-risk patients and within the first hours from symptom onset. Pharmacological Facilitation in Primary Angioplasty 27 Proposed strategy for STEMI Local hospitals/out of hospital diagnosis of STEMI Heparin 70 U/kg + Asprin 500 mg + Clopidogrel 600 mg Time from symptom onset to medical contact Increasing loss of myocytes if delay reperfusion < 3 hours Abciximab+1/2 lytic Contraindication to lytics or elderly pts Abciximab* PCI centers Low risk Complete ST-resolution High risk PTCA/stent Semielective PTCA/stent PCI centers Invasive Invasive Invasive Abciximab PCI centers Partial or No ST-resolution Invasive > 3 hours Invasive PTCA/stent PTCA/stent PTCA/stent FIGURE 3 Proposed reperfusion strategy for ST-elevation myocardial infarction (STEMI) based on the time from symptom-onset to medical contact and risk profile.